General Principles of the Hybrid Approach in Hypoplastic Left Heart Syndrome

  • Darren P. BermanEmail author
  • John P. Cheatham


Congenital heart disease remains the most common form of birth defect and occurs in ~1 % of all live births. Hypoplastic left heart syndrome (HLHS) occurs in 2–3/10,000 live births in the USA [1]. It was uniformly fatal through the 1970s until the Norwood surgical palliation was proposed in 1980 [2]. When done properly, this operation, and its Sano modification, achieves a tenuous but stable circulation as a first step in palliation for HLHS. Less traumatic neonatal palliation has since been pursued as an alternative to the Norwood operation. Gibbs et al. first described neonatal stenting of the arterial duct combined with pulmonary artery banding and atrial septectomy or septostomy as an alternative palliation for HLHS in 1993 [3]. Since that time hundreds of articles have been published describing variations on technique and outcomes from this so-called hybrid approach to HLHS.


Pulmonary Blood Flow Hypoplastic Left Heart Syndrome Atrial Septum Pulmonary Artery Banding Branch Pulmonary Artery 
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  1. 1.
    Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr. 2008;153(6):807–13.CrossRefPubMedPubMedCentralGoogle Scholar
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    Norwood WI, Kirklin JK, Sanders SP. Hypoplastic left heart syndrome: experience with palliative surgery. Am J Cardiol. 1980;45(1):87–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR. Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J. 1993;69(6):551–5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.The Heart CenterNationwide Children’s HospitalColumbusUSA
  2. 2.Pediatrics & Internal MedicineThe Ohio State UniversityColumbusUSA

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